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Innovation in Homeless Services: The social, economic and community value of  tackling homelessness through Housing First approaches
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Innovation in Homeless Services: The social, economic and community value of tackling homelessness through Housing First approaches


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  • 1. Sam Tsemberis, PhD Founder and CEO Pathways to Housing, Inc. JUNE 12, 2013
  • 2. Who is served by Housing First?  Homeless  Mental health problems Addiction and abuse  Health problems  Poverty  Isolation  Stigma  PTSD/Trauma
  • 3. Frequent users of acute care services Jail Shelter Hospital/ Detox Streets Institutional Circuit
  • 4. Housing and Support Services: Rearranged (Housing first) and Redesigned (consumer driven)
  • 5. Levels of Program Fidelity consumers Hundreds of choices, change over time & have tradeoffs r Management issues include team- consumer, landlord-tenant, landlord- team, and team-agency interactions Operations Variety of services and housing options Decisions about housing status and consumer engagement Principles Consumer choice Separation of housing and treatment
  • 6. Homeless Shelter placement Transitional housing Permanent housing Ongoing, flexible support Harm Reduction Housing First Model
  • 7. MHCC At Home / Chez Soi 5 Cities RCT N=2,257 Moncton, Montreal, Toronto, Winnipeg, Vancouver Housing First (n=1267) Interviews every 3 months: Residential stability, mental health, addiction, quality of life, social integration Treatment as Usual (n=990)
  • 8. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 3M 6M 9M 12M Time Spent in Stable Housing Over Year One HF TAU
  • 9. / 9 Housing First shows cost offsets Annualized costs: Total sample Annualized costs: High Service Users (defined as those in top 10% of prior service costs TAU Intervention Difference TAU Intervention Difference Est. annual cost: Non-study services $23,849 $14,599 $ (9,250) $ 56,431 $30,216 $ (26,215) Est. annual intervention cost $17,160 $ 17,160 $16,825 $16,825 Total $ 23,849 $ 31,759 $ 7,910 $ 56,431 $ 47,041 $ (9,390) High Service Users: • There is an overall savings of $9,390 per person per year • Every dollar spent on Housing First for these participants saves $1.56 through reduced use of other shelter, health and justice services Total Sample: • An investment in Housing First requires only an additional investment of $7910 per year • For every dollar spent 54 cents is saved through reduced use of other shelter and health are services after only one year Table 1 – Costs of Housing First versus use of other health, justice and social services after one year
  • 10. Peer Support: Recovery Focused Mental Health Services Hope-instilling practice Socially supported wellness knowledge and skills to self- manage Emphasis on holistic wellness and positive lifestyle as healing
  • 11. Son returns from tour in Afghanistan and stays with (formerly homeless) dad in his apartment. Social connections are key and and housing should adjusts accordingly
  • 12. Community-based, Residential Treatment (on-site clinical staff) Permanent Single Site (on-site services) Permanent housing (scatter-site, off site services) Redesigning the System: System Transformation Longer term Institutional Care Least restrictive to more restrictive setting
  • 13. • People are much more capable than we imagined possible. Capabilities
  • 14. For Additional Information Web sites:  Or send an email to